Maternal Disintegrative Responses in the Context of Infant Care: Their Role in the Association Between Early Childhood Experiences and Personal and Maternal Aspects

Background: Along with the pleasure and satisfaction that usually accompany the experience of infant care, the high demands of early maternal caregiving and deep sense of responsibility for the vulnerable and helpless infant can also trigger stressful and negative experiences. In addition to depression and anxiety, which have been extensively studied, a woman's negative experiences may be reflected in a wide range of disoriented and disintegrative responses, such as intrusive thoughts and dissociative experiences. Although these disintegrative responses may cause considerable distress, they have received little attention in the empirical, therapeutic, or social discourse.

Objectives: In view of the lack of instruments relating specifically to maternal disintegrative responses during early maternal caregiving, in this set of studies, we first sought to develop and validate a self-report questionnaire that would examine a broad spectrum of mothers’ intrusive thoughts and dissociative experiences as expressed in infant care in the postpartum period. Thus, in Studies 1 and 2 (articles 1 and 2), we developed and validated a short bidimensional scale, entitled the Maternal Disintegrative Responses Scale (MDRS). In addition, we examined the relationship of its two dimensions with attachment style and childhood trauma experiences. In the next step, relying on Belsky's parenting model (1984), which stresses the contribution of the parent's developmental history, as well as their psychological functioning and personality traits, to their parenting, in Study 3 (described in articles 3 and 4), we examined, in two phases during the first year after childbirth, the role of maternal disintegrative responses in the association between the mother's developmental history, i.e., adverse and benevolent childhood experiences, and several parenting outcomes: maternal self-efficacy, role satisfaction, and maternal reflective functioning. Furthermore, in order to obtain a broader picture of both the negative and positive variables, we examined the possible mediating and moderating roles of personal aspects of the mother (self-compassion and personal growth) to the parenting outcomes.

Methods: All studies were based on convenience samples recruited through social media networks, with the data collected by means of an electronic version of self-report questionnaires (using Qualtrix software).  Participants in Study 1 (article 1) consisted of 455 mothers aged 21–47 years (M=32.12, SD=5.01) whose babies were up to 12 months old (M=4.88, SD=3.13). The participants completed questionnaires assessing MDRS, postnatal depression, childbirth‐related post‐traumatic stress disorder, obsessive‐compulsive disorder, and general symptoms of dissociation. Study 2 (article 2) employed two samples. Sample 1 consisted of 249 women aged 19 to 43 (M= 30.10, SD= 4.90) whose infants were up to 12 months old. The participants completed questionnaires assessing trait anxiety, attachment orientation, along with the MDRS, and a background inventory. Sample 2 consisted of 637 women aged 20 to 46 (M= 31.43, SD= 4.81) whose infants were up to 16 weeks old. Participants completed questionnaires assessing psychological distress and adverse childhood experiences, as well as the MDRS, and a background inventory. In Study 3 (articles 3 and 4), the sample was comprised of 385 women aged 20 to 45 (M= 31.42, SD=  4.77)  who completed questionnaires 16 weeks after childbirth (Phase 1) and 6-10 months postpartum (Phase 2). The instruments assessed their adverse and benevolent childhood experiences (Phase 1), maternal disintegrative responses, self-compassion, and personal growth (Phases 1 and 2), as well as maternal self-efficacy, role satisfaction, and maternal reflective functioning (consisting of three dimensions: pre-mentalizing modes, certainty about mental states, and interest and curiosity).

Results:  The findings of Studies 1 and 2 indicated good psychometric properties for the MDRS, providing evidence of its reliability and validity. More specifically, Study 1 showed that the MDRS consists of 8 items tapping two dimensions, intrusive thoughts and dissociative experiences, and displays good psychometric properties. Both factors were found to be related to postnatal depression, childbirth‐related post‐traumatic stress disorder, obsessive‐compulsive disorder, and general symptoms of dissociation. In addition, primiparous women scored higher than multiparous women on both dimensions, and mothers of infants up to 3 months old scored higher on dissociative experiences than those whose infants were aged 4-12 months. Study 2 confirmed, in two samples, the factor structure of the MDRS. In addition, insecure attachment and childhood trauma were both related to the MDRS factors, above and beyond the woman's background characteristics and current level of anxiety or distress. Study 3 (articles 3 and 4) demonstrated the role of maternal disintegrative responses in the associations between childhood experiences and maternal outcomes. Although path analysis found no direct relationships between adverse or benevolent childhood experiences and maternal self-efficacy or role satisfaction, significant serial indirect effects were found for maternal disintegrative responses and self-compassion in both Phase 1 and Phase 2 (article 3). Finally, the mediation model, described in article 4, revealed that maternal dissociative experiences fully mediated the relationship between adverse childhood experiences and pre-mentalizing modes. In addition, maternal intrusive thoughts fully mediated the relationship between adverse childhood experiences and certainty about mental states. However, the moderated mediation model revealed that these mediated relationships were dependent on the level of personal growth reported by the mother (article 4).

Conclusions and Implications: The findings provide promising evidence to suggest that the MDRS is a reliable and valid measure and can therefore facilitate understanding of more latent and suppressed expressions of distress and negative responses among mothers in the postpartum period, beyond depression and anxiety. In addition, in line with the research model, the findings indicate the important role of maternal disintegrative responses in the relationship between a mother's childhood experiences and her parenting outcomes, showing both negative and positive trajectories. On the one hand, the findings highlight the risk of mothers with adverse childhood experiences to experience more disintegrative responses and accordingly report poorer parental outcomes. On the other hand, the study highlights the importance of benevolent childhood experiences, self-compassion, and personal growth as variables that are related to positive parenting outcomes and may reduce the negative consequences that disintegrating responses might have on the mother’s parenting. The MDRS can be used by professionals to support their work with mothers of young infants, helping to identify those who are frequently troubled by intrusive thoughts and dissociative experiences. The current set of studies suggests that mothers with adverse childhood experiences may be especially at risk. Professionals who work with women in the postpartum period should be aware of this possibility and make an effort to help those in need of support to process their thoughts and feelings toward the infant and toward themselves as mothers, starting from an early stage postpartum. Addressing these issues can contribute to mothers’ mental health by aiding them to develop a positive and sensitive relationship with their infant, as well as a more positive perception of themselves. In addition, clinicians and other professionals can seek to strengthen mothers’ awareness of their positive personal resources, such as self-compassion and personal growth, as well as their ability to rely on benevolent childhood experiences, and thus empower them and increase their confidence and positive experience as mothers.